High-Performing Practices Highlight Innovations to Address Burnout

PHILADELPHIA—Only one-third of physicians in the United State practice primary care, compared to about one half in other developed nations. Those that stay in the field are on the edge of burnout that could be addressed by redesigning how care is organized, according to research funded by the ABIM Foundation published in the Annals of Family Medicine. Citing lower payments, frustrating models of practice and long hours of clerical work that doesn’t utilize their training, fewer aspiring physicians are choosing to focus in primary care, threatening the quality of care patients receive. The authors write that “joy is in short supply.”

To increase physician’s work-life satisfaction, attract future physicians to the field and improve the quality of patient care, authors Christine A. Sinsky, MD, Rachel Willard-Grace, MPH, Andrew M. Schutzbank, MD, Thomas A. Sinsky, MD, David Margolius, MD, and Thomas A. Bodenheimer, MD of “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices” sought to identify challenges facing primary care practices and innovations that could facilitate and restore joy in practice.

Researchers conducted visits to 23 high-performing sites across the United States that revealed common problems among primary care practices, including visits that were disorganized or rushed, the inability of patients to see their primary care physician for a same day visit, long hours spent by physicians on documentation, and communication issues arising from inefficient design of the physical office space and location of clinical care team members.

“Primary care is the backbone of our health care system, but our current design adds too many non-clinical duties to a physician’s already demanding workload,” said Christine A. Sinsky, MD, a general internist with Medical Associates Clinic and Health Plans in Dubuque, Iowa and corresponding author of the paper. “Innovations from these sites can reduce the responsibilities placed on physicians by engaging other members of the care team and restoring joy and job satisfaction by allowing them to focus on what they are trained for—taking good care of their patients.”

Chief among the authors’ suggestions for improvements is a movement from a physician-centric model of work distribution to a shared-care model with higher levels of clinical support of physicians and frequent forums for communication that can result in high-functioning teams, improved professional satisfaction and greater joy in practice.

The authors also found several other common themes among sites with high-levels of satisfaction, including:

• Proactive planned care, with pre-visit planning and pre-visit laboratory tests;
• Sharing clinical care among a team, with expanded rooming protocols, standing orders and panel management;
• Sharing clinical tasks with collaborative documentation (scribing), non-physician order entry and streamlined prescription management;
• Improving communication by verbal messaging and in-box management; and,
• Improving team functioning through co-location, team meetings and work flow mapping.

The research informed a 2012 conference of the ABIM Foundation entitled, Primary Care Innovation: Improving the Efficiency and Appeal of Practice: “How Did They Do That?” The conference brought together representatives from the visited practices with leaders in primary care to reflect on the research findings, identify a set of principles that could transform the efficiency and appeal of practice, and consider how those principles could be spread more widely.

The authors conclude that the core work of primary care remains rewarding and meaningful, but without a shift to a shared-care model, physicians will continue to experience low levels of satisfaction and burnout. Revitalization of primary care and innovation can result in much needed improvements in quality and efficiency greater joy in practice.

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